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HCC Surety Group 601 South Figueroa Street Suite 1600 Los Angeles California 90017 AUTHORIZATION TO CHARGE CREDIT/DEBIT CARD The undersigned authorizes AMERICAN CONTRACTORS INDEMNITY COMPANY UNITED STATES SURETY COMPANY or U.S. SPECIALTY INSURANCE COMPANY hereafter called HCC SURETY to charge the credit/debit card listed below. This authority is to remain in full force and effect until HCC SURETY has received written notification from me of its termination 10 days prior to the next scheduled...charge date. HCC SURETY reserves all of its rights and defenses pursuant to the applicable bond s agreement s including indemnity agreement s the law or otherwise. CREDIT/DEBIT CARD INFORMATION CARD TYPE VISA MASTERCARD DISCOVER AMERICAN EXPRESS CARD NUMBER CARD EXPIRATION DATE CARD SECURITY CODE see below CARDHOLDER INFORMATION CARDHOLDER NAME CREDIT CARD BILLING ADDRESS Office Use Only To be completed by HCC Surety PAYMENT DETAIL PAYMENT TYPE PREMIUM SUBROGATION OTHER BOND/CLAIM/COLLATERAL...NUMBER AGENCY ID PRINCIPAL S NAME if different than cardholder NAME OF HCC SURETY ASSOCIATE MONITORING REIMBURSEMENT S ONE TIME PAYMENT AMOUNT RECURRING PAYMENTS INITIAL DOWN PAYMENT DOWN PAYMENT AMOUNT RECURRING PAYMENT FINAL PAYMENT st th DAY OF THE MONTH TOTAL NUMBER OF RECURRING PAYMENTS TO BE AUTO BILLED including the final payment NUMBER OF PAYMENTS LAST SCHEDULED RECURRING PAYMENT DATE Card security code is the three digit code on the back of Visa or MasterCard or the four digit code on...the front of American Express. The last scheduled recurring payment may be recalculated in the event that any of the recurring payments are not made as scheduled* I hereby declare that I am the holder of the above credit/debit card. I authorize the above mentioned amounts to be charged to the credit/debit card per the terms indicated herein* Cardholder s signature Date For cardholder security please submit the signed form via fax to 310 649-1061 or e-mail to CCPayments hccsurety. This authority...is to remain in full force and effect until HCC SURETY has received written notification from me of its termination 10 days prior to the next scheduled charge date. HCC SURETY reserves all of its rights and defenses pursuant to the applicable bond s agreement s including indemnity agreement s the law or otherwise. HCC SURETY reserves all of its rights and defenses pursuant to the applicable bond s agreement s including indemnity agreement s the law or otherwise. CREDIT/DEBIT CARD INFORMATION...CARD TYPE VISA MASTERCARD DISCOVER AMERICAN EXPRESS CARD NUMBER CARD EXPIRATION DATE CARD SECURITY CODE see below CARDHOLDER INFORMATION CARDHOLDER NAME CREDIT CARD BILLING ADDRESS Office Use Only To be completed by HCC Surety PAYMENT DETAIL PAYMENT TYPE PREMIUM SUBROGATION OTHER BOND/CLAIM/COLLATERAL NUMBER AGENCY ID PRINCIPAL S NAME if different than cardholder NAME OF HCC SURETY ASSOCIATE MONITORING REIMBURSEMENT S ONE TIME PAYMENT AMOUNT RECURRING PAYMENTS INITIAL DOWN PAYMENT DOWN PAYMENT...AMOUNT RECURRING PAYMENT FINAL PAYMENT st th DAY OF THE MONTH TOTAL NUMBER OF RECURRING PAYMENTS TO BE AUTO BILLED including the final payment NUMBER OF PAYMENTS LAST SCHEDULED RECURRING PAYMENT DATE Card security code is the three digit code on the back of Visa or MasterCard or the four digit code on the front of American Express.

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Understanding the Authorization to Charge Credit/Debit Form

What is the authorization to charge credit/debit form?

The authorization to charge credit/debit form is a document that allows vendors or service providers to charge agreed-upon amounts to a customer's credit or debit card. This form typically outlines the amount to be charged, frequencies of the charges, and the cardholder's consent, thus ensuring clear communication and a mutual understanding of payment terms.

Key features of the authorization to charge credit/debit form

This form includes essential elements such as the cardholder's personal information, card details, payment type, and the specific amounts authorized for each transaction. It also specifies whether payments are one-time or recurring, and it may include terms for adjusting charges in case of late payments.

Who needs the authorization to charge credit/debit form?

Businesses and individuals in various sectors often require this form from their clients, particularly in situations involving subscription services, contractual agreements, or ongoing financial obligations. This document protects both parties by formalizing financial arrangements and ensuring that charges are made only with consent.

How to fill the authorization to charge credit/debit form

Filling out this form involves entering accurate card information, including the card type, number, expiration date, and security code. Additionally, the cardholder must provide personal identifying details such as their name and billing address. It is essential to clearly indicate the payment type and amounts authorized, specifying whether they are one-time or recurring. Any optional clauses regarding termination of authorization should also be discussed and documented.

Best practices for accurate completion

To ensure the form is completed correctly, double-check all entered information for accuracy, including card numbers and amounts. Have a clear discussion with the service provider about the terms and conditions of the charges to avoid any misunderstandings. It is also advisable to keep a copy of the completed form for personal records and future reference.

Security and compliance for the authorization to charge credit/debit form

Maintaining security and compliance when handling payment information is crucial. This includes following the Payment Card Industry Data Security Standards (PCI DSS) to protect the cardholder’s data. Providers must ensure that the information is stored safely and used only for the agreed purposes, helping to build trust with customers while safeguarding sensitive information.

Frequently Asked Questions about american contractors indemnity company form

What happens if I want to cancel my authorization?

To cancel an authorization, you should provide written notification to the vendor or service provider, following the terms outlined in your authorization form. This ensures that your request is documented and processed correctly.

Are there specific regulations for different states?

While the basic format of the authorization to charge credit/debit card form is generally recognized across the United States, certain states may have unique regulations regarding payment processing and consumer protection. It is advisable to check local laws or consult a legal expert.

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